title: Leflunomide as a corticosteroid-sparing agent in giant cell arteritis and polymyalgia rheumatica: a case series.
abstract: OBJECTIVE
  Giant cell arteritis (GCA) and polymyalgia rheumatica (PMR) affect individuals older than 50 years of age and corticosteroids are the mainstay of treatment. The aim of our study was to explore the role of leflunomide as a corticosteroid-sparing agent in GCA and PMR patients.
  
  
  METHODS
  Patients with difficult-to-treat GCA and PMR were retrospectively identified in the period from 2010 to 2013. The doses of corticosteroids and CRP values were noted before, after three months, and at the end of the treatment with leflunomide (for patients continuing treatment, censoring date was January 1, 2013).
  
  
  RESULTS
  Twenty-three patients were identified (12 with PMR and 11 with GCA). A reduction of 6 mg/dL (CI 95% -10.9-34.2, P = 0.05) in CRP and 3.7 mg (CI 95% 0.5-7.0, P = 0.03) in prednisolone dose was observed in the PMR group. In GCA patients, the reduction was 12.4 mg/dL (CI 95% 0.7-25.5, P = 0.06) in CRP and 6.6 mg (CI 95% 2.8-10.3, P < 0.01) in prednisolone dose.
  
  
  CONCLUSIONS
  Leflunomide seems to be effective as a corticosteroid-sparing agent in patients with difficult-to-treat GCA and PMR. Randomized controlled trials are warranted in order to confirm the usefulness of leflunomide in the therapy of GCA/PMR.
authors.affiliation: Department of Rheumatology, Hospital of Southern Norway Trust Kristiansand, Service Box 416, 4604 Kristiansand, Norway ; Faculty of Medicine, Norwegian University of Science and Technology, Service Box 8905, 7491 Trondheim, Norway.
authors.forename: Andreas P
authors.initials: AP
authors.lastname: Diamantopoulos
authors.forename: Helene
authors.initials: H
authors.lastname: Hetland
authors.forename: Geirmund
authors.initials: G
authors.lastname: Myklebust
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage; D000368:Aged; D005260:Female; D013700:Giant Cell Arteritis / Q000188:drug therapy* / Q000473:pathology; D015726:Giant Cells / Q000187:drug effects; D006801:Humans; D007555:Isoxazoles / Q000008:administration & dosage*; D000077339:Leflunomide; D008297:Male; D008875:Middle Aged; D011111:Polymyalgia Rheumatica / Q000188:drug therapy* / Q000473:pathology
chemical_list: D000305:Adrenal Cortex Hormones; D007555:Isoxazoles; D000077339:Leflunomide